肠系膜上动脉夹层的MSCT血管成像

Analysis of multi-slice CT angiography in superior mesenteric artery dissection

目的:探讨多层螺旋CT血管成像(MSCTA)在诊断肠系膜上动脉夹层(SMAD)中的价值。方法:回顾性分析我院临床漏诊、经CTA诊断为SMAD后经手术或DSA证实的16例患者的临床及CT影像资料。所有患者均行MSCTA检查,并采用MPR、CPR、MIP和VR技术进行图像后处理。总结SMAD的CTA特征表现,分析临床漏诊的原因。结果:SMAD主要CT表现:16例患者均可见SMA为双腔结构,可见内膜片,其中7例患者假腔内可见新月形充盈缺损。CT横轴面和三维重组图像能清楚显示11例患者肠系膜上动脉夹层的范围和程度。SMAD患者的主要临床表现是急性或慢性腹痛、以中上腹为主,无特异性,临床医师未认识到MSCTA诊断SMAD的价值是导致漏诊或误诊的原因。结论:MSCTA能提供评估肠系膜上动脉夹层的可靠信息,临床医师和影像医师应该认识其价值,重视对肠系膜上动脉夹层的观察。

Objective：To explore the value of multi slice CT angiography （MSCTA） in the diagnosis of superior ruesenteric artery dissection （SMAD）. Methods：Clinical and CT data of 16 patients with SMAD missed by clinical doctors, diagnosed by CT and confirmed by surgery or DSA were retrospectively analyzed. All patients underwent MSCTA, and the CTA data were postprocessed with MPR,MIP,CPR and VR techniques. CTA characteristics of SMAD and the reasons of misdi- agnosis were analyzed. Results：The main manifestations of SMAD：true and false lumens and intimal flap were found in 16 eases,a crescent-shaped filling defect in false lumen was showed in 7 cases. The range and extent of SMAD were clearly dis- played by axial images of CTA combined with 3D postprocessed images in all cases. Acute or chronic abdominal pain mainly in the middle and upper abdomen were the main clinical manifestation of SMAD and was non-specific,and the clinicians ap- peared far from fully understanding the value of MSCTA for diagnosis of SMAD, which was the main reason of missed diag- nosis. Conclusion： MSCTA can provide reliable information to assess SMAD,clinicians and radiologists should recognize its value and pay attention to observation on the superior mesenteric artery dissection.